Provider Demographics
NPI:1447302435
Name:MARCUS, SANDER IRA (PHD)
Entity type:Individual
Prefix:DR
First Name:SANDER
Middle Name:IRA
Last Name:MARCUS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9772 S. VANDERPOEL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1232
Mailing Address - Country:US
Mailing Address - Phone:773-233-3030
Mailing Address - Fax:
Practice Address - Street 1:3105 S. DEARBORN, SUITE 226
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3793
Practice Address - Country:US
Practice Address - Phone:312-567-3358
Practice Address - Fax:312-567-8948
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical